Lack of insurance tied to more emergency surgery: study

NEW YORK (Reuters Health) - The type of insurance people
have is tied to their risk of needing emergency aorta surgery,
according to a new study. Insurance, or lack thereof, is also
linked to how well those people fare after surgery.

Compared to people with private insurance, people without
insurance were more likely to need emergency surgery on their
aorta, the largest artery that supplies blood to every part of
the body. They were also more likely to die or have
complications after surgery.

"It would appear that if you don't have insurance - and
assuming you're not getting preventive healthcare . . . then you
are probably at a higher risk of having an aortic catastrophe
and, if you have one, you're more likely to die or have a
complication," Dr. G. Chad Hughes told Reuters Health.

Hughes is the study's senior author from Duke University
Medical Center in Durham, North Carolina.

Conditions affecting the aorta, such as a bulge or break in
the artery's walls, are responsible for 30,000 to 60,000 deaths
every year in the U.S., he and his colleagues write in the
journal Circulation: Cardiovascular Quality and Outcomes.

Less than 5 percent of patients die during a scheduled
surgery to repair a diseased part of the aorta, they write. The
death rate increases to about 50 percent when the surgery is
done during an emergency, such as when the aorta ruptures or
breaks.

About 40 percent of aortic surgeries are performed as
emergencies. Catching some of those cases early and repairing
the diseased aorta during a scheduled surgery may increase the
number of people who survive.

It's known that people with insurance tend to get better
care to prevent conditions that contribute to the risk of aortic
disease, like high blood pressure and high cholesterol. The
researchers suggest insured people may also be more likely to
have scheduled aortic surgery - instead of waiting until the
aorta ruptures.

For the new study, Hughes and his colleagues used a national
database that tracks heart-related procedures at 1,091
healthcare centers across the U.S.

They compared the type of aorta surgeries and outcomes
experienced by 51,282 people with private insurance, public
insurance or no insurance. The study specifically looked at
surgeries conducted between 2007 and 2011 that fixed the part of
the aorta located in the chest.

Among people younger than 65 years old, about 36 percent of
those with private insurance needed emergency or urgent surgery,
compared to about 73 percent of people with no insurance. The
others had scheduled surgery.

People with Medicaid, the state and federal health insurance
for the poor, were also more likely to need urgent or emergency
surgery than those with private insurance.

What's more, uninsured patients and those with Medicaid and
Medicare, the federal health insurance for the elderly and
disabled, were more likely than people with private insurance to
die or have complications. Those complications included
developing an infection, having a stroke or needing another
operation.

Patients age 65 and older were also more likely to undergo
emergency or urgent surgery if they lacked insurance, but there
was no difference in their complication rates based on insurance
type. Any possible effect of insurance may have been dampened by
older patients already having a tendency to have poorer outcomes
after surgery.

"There's a preponderance of evidence that shows findings
similar to this that uninsured patients tend to present with
more advanced disease," Dr. Andrew Loehrer said. "I think this
paper adds to that literature."

Loehrer, who is from Massachusetts General Hospital in
Boston, was not involved with the new study but has researched
surgical access and outcomes among low-income populations.

"It's been challenging to dissect exactly why that is," he
said, because people without insurance or with Medicaid may
already be in poorer health and have other traits that could
affect how well they fare after surgery.

Hughes said researchers will have to examine how increased
insurance access through the Affordable Care Act, commonly known
as Obamacare, may influence these results over the coming years.

"I figured we'd see exactly what we saw," he said. "I think
the question is, if you get these people coverage, will that
make a difference? The answer right now is, we don't know."